S.F. 2259 Section 1. NEW SECTION . 514C.26 Polypharmacy evaluation 1 —— coverage. 2 1. Notwithstanding the uniformity of treatment requirements 3 of section 514C.6, a contract, policy, or plan providing for 4 third-party payment or prepayment of health or medical expenses 5 shall provide coverage for polypharmacy evaluation. For the 6 purposes of this section, polypharmacy evaluation must include 7 a medication review, the issuance of a medication review 8 report, and patient notification. 9 a. A medication review shall meet all of the following 10 requirements: 11 (1) Is a comprehensive review of a patient’s medication list 12 by a licensed pharmacist for the purpose of identifying drugs 13 and drug interactions which might put the patient at risk for 14 falls and other serious medical consequences. 15 (2) Is requested by a licensed health care provider who is 16 authorized to prescribe medications. 17 (3) The patient is seventy years of age or older. 18 (4) The patient is prescribed more than five medications. 19 b. A medication review report shall meet all of the 20 following requirements: 21 (1) Is a report issued by the reviewing pharmacist to the 22 requesting physician and the patient summarizing the findings 23 of the review. 24 (2) Contains the list of medications reviewed, the 25 patient’s name and other pertinent identification information, 26 identifies any drug interactions, identifies any dosing 27 abnormalities, and identifies drugs identified as potentially 28 dangerous to the geriatric population. 29 c. A patient notification is the notification provided to 30 the patient in addition to the medication review report and 31 shall include all of the following: 32 (1) An explanation of the medication review. 33 (2) A brief self-evaluation questionnaire used to identify 34 individuals at high risk for falls or other serious medical 35 -1- LSB 6103XS (2) 83 pf/nh 1/ 6

S.F. 2259 consequences. 1 (3) Instructions to the patient regarding the role of 2 polypharmacy in causing falls or other serious medical 3 consequences. 4 (4) Locations where the patient may be screened for 5 orthostatic hypotension. 6 (5) Instructions to the patient to seek medical attention 7 if the patient has symptoms that put the patient at risk for 8 falls including but not limited to light-headedness, visual or 9 balance disturbances, or generalized weakness. 10 2. The provisions of this section shall apply to all of the 11 following classes of third-party payment provider contracts, 12 policies, or plans delivered, issued for delivery, continued, 13 or renewed in this state on or after July 1, 2010: 14 a. Individual or group accident and sickness insurance 15 providing coverage on an expense-incurred basis. 16 b. An individual or group hospital or medical service 17 contract issued pursuant to chapter 509, 514, or 514A. 18 c. An individual or group health maintenance organization 19 contract regulated under chapter 514B. 20 d. An individual or group Medicare supplemental policy, 21 unless coverage pursuant to such policy is preempted by federal 22 law. 23 e. A plan established pursuant to chapter 509A for public 24 employees. 25 3. This section shall not apply to accident-only, specified 26 disease, short-term hospital or medical, hospital confinement 27 indemnity, credit, dental, vision, long-term care, basic 28 hospital, and medical-surgical expense coverage as defined 29 by the commissioner, disability income insurance coverage, 30 coverage issued as a supplement to liability insurance, 31 workers’ compensation or similar insurance, or automobile 32 medical payment insurance. 33 4. The commissioner of insurance shall adopt rules pursuant 34 to chapter 17A as necessary to administer this section. In 35 -2- LSB 6103XS (2) 83 pf/nh 2/ 6

S.F. 2259 addition to any other rules adopted, the commissioner of 1 insurance shall collaborate with the department of public 2 health to adopt rules to require health care providers who 3 request polypharmacy evaluations to report aggregated patient 4 information to the department of public health to enable the 5 department to assess the costs and benefits of polypharmacy 6 evaluations. 7 5. For the purposes of this section, “polypharmacy” 8 means the prescribing of multiple medications to a patient 9 by licensed health care providers authorized to prescribe 10 medications and the use of such medications by the patient. 11 Sec. 2. FALL PREVENTION PILOT PROJECT. 12 1. Purposes. The department of public health shall 13 establish a fall prevention pilot project. The project shall 14 be principally directed to older individuals, their families 15 and caregivers, and health care professionals. The purposes of 16 the pilot project are to develop effective strategies to reduce 17 the risk of falls among older individuals and to reduce the 18 injuries and costs associated with such falls. 19 2. Goals. To the extent practicable the pilot project shall 20 achieve the following goals: 21 a. Increase the awareness among older individuals, 22 physicians, pharmacists, health care professionals, 23 community-based health organizations, and others, of fall risk 24 factors and actions that can reduce falls. 25 b. Implement and evaluate strategies and interventions that 26 are proven effective in reducing falls among older individuals 27 in order to tailor such strategies and interventions to 28 specific populations of older individuals in this state. 29 c. Improve the identification, diagnosis, treatment, and 30 rehabilitation of older individuals who have a high risk of 31 falling and who are fall victims. 32 d. Improve data collection and analysis to identify risk 33 factors for falls and factors that reduce the likelihood of 34 falls. 35 -3- LSB 6103XS (2) 83 pf/nh 3/ 6

S.F. 2259 e. Assess the risk of falls occurring in various settings. 1 f. Identify barriers to the adoption of proven interventions 2 with respect to the prevention of falls among older 3 individuals. 4 g. Improve collaboration among the medical community 5 including physicians, health care providers, and pharmacists to 6 reduce the rate of falls among older individuals. 7 h. Improve coordination of existing resources to address 8 fall prevention among older individuals. 9 3. Elements of pilot project. The pilot project shall 10 include all of the following: 11 a. The creation of a multidisciplinary task force to 12 coordinate community intervention. 13 b. Development of a plan for community outreach and 14 education relating to all of the following: 15 (1) Physical conditioning and balance. 16 (2) Polypharmacy and its role in causing falls. 17 (3) Techniques for fall prevention and fall recovery. 18 (4) Screening for orthostatic hypotension. 19 c. Development of a plan to demonstrate injury prevention 20 and medical cost savings from intervention, including the 21 polypharmacy evaluation specified in section 514C.26. 22 4. Implementation. The department of public health shall 23 select one of the area agencies on aging as designated pursuant 24 to section 231.32 to implement the pilot project for an initial 25 period of three years. 26 5. Reports. The department of public health shall provide 27 annual progress reports regarding the pilot project, and 28 shall provide a final report which includes outcomes of the 29 project and recommendations for continuation, expansion, 30 or modification of the pilot project. The department’s 31 reports shall include, to the extent available, information 32 collected and analyzed pursuant to section 514C.26 regarding 33 the costs and benefits attributable to the use of polypharmacy 34 evaluations by licensed health care providers authorized to 35 -4- LSB 6103XS (2) 83 pf/nh 4/ 6

S.F. 2259 prescribe medications. 1 6. Definitions. As used in this section, unless the context 2 otherwise requires: 3 a. “Older individual” means older individual as defined in 4 section 231.4. 5 b. “Orthostatic hypotension” means a drop in blood pressure 6 during rapid changes in body positioning including but not 7 limited to moving from a sitting to a standing position. 8 c. “Polypharmacy” means the prescribing of multiple 9 medications to a patient by a health care provider authorized 10 to prescribe medications and the use of such medications by the 11 patient. 12 Sec. 3. APPROPRIATION. There is appropriated from the 13 general fund of the state to the department of public health 14 for the fiscal period beginning July 1, 2010, and ending 15 June 30, 2013, the following amount or so much thereof as is 16 necessary to be used for the purpose designated: 17 For implementation through an area agency on aging of the 18 fall prevention pilot project as specified in this Act: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 100,000 20 EXPLANATION 21 This bill relates to fall prevention among older 22 individuals. The bill directs the department of public 23 health (DPH) to establish a fall prevention pilot project for 24 an initial period of three years, principally directed to 25 older individuals, their families and caregivers, and health 26 care professionals. The purposes of the pilot project are 27 to develop effective strategies to reduce the risk of falls 28 among older individuals and to reduce the injuries and costs 29 associated with such falls. The bill provides goals for the 30 pilot project, elements of the pilot project, provides for 31 implementation of the pilot project by an area agency on aging 32 selected by DPH, and requires annual progress reports and a 33 final report by DPH regarding the pilot project. 34 The bill requires that a contract, policy, or plan providing 35 -5- LSB 6103XS (2) 83 pf/nh 5/ 6

S.F. 2259 for third-party payment or prepayment of health or medical 1 expenses shall provide coverage for polypharmacy evaluation. 2 A polypharmacy evaluation must include a medication review, 3 the issuance of a medication review report, and patient 4 notification, and the bill specifies the requirements for 5 each of these elements. The requirement applies to specified 6 classes of third-party payment provider contracts, policies, 7 or plans delivered, issued for delivery, continued, or renewed 8 in this state on or after July 1, 2010. The bill directs the 9 commissioner of insurance to adopt rules pursuant to chapter 10 17A as necessary to administer the bill. In addition to these 11 rules the commissioner of insurance is directed to collaborate 12 with the department of public health to adopt rules to require 13 health care providers who request polypharmacy evaluations to 14 report aggregated patient information to the department of 15 public health to enable the department to assess the costs 16 and benefits of polypharmacy evaluations. The bill defines 17 “polypharmacy” as the prescribing of multiple medications 18 to a patient by a licensed health care provider authorized 19 to prescribe medications and the use by the patient of such 20 medications. 21 The bill appropriates $100,000 from the general fund of the 22 state to DPH for the three-year pilot program. 23 -6- LSB 6103XS (2) 83 pf/nh 6/ 6